A bold, beautiful strategy for Trump’s medical marijuana policy

President Trump recently called marijuana policy “very complicated” while noting he had “heard great things” about medical marijuana.

He is right on both counts — medical cannabis policy is complex, but the benefits are undeniable. With the right leadership, it is a challenge worth tackling. 

He’s not alone in this view. Former Rep. Bob Barr (R-Ga.), who once blocked Washington, D.C., from implementing medical cannabis laws, recently argued that marijuana’s status as a Schedule I drug “creates major barriers for researchers and doctors,” and that the idea cannabis has “no known medical use” is “clearly outdated.”   

Barr added that cutting red tape would support hundreds of thousands of jobs and advance therapeutic breakthroughs.

Just weeks ago, a coalition of more than 40 patient organizations (including my organization), representing tens of millions of Americans, urged appropriators in an open letter to maintain protections for medical programs, calling medical marijuana programs “a lifeline for millions of Americans.” 

The letter called for “comprehensive, permanent federal legislation” to “align federal cannabis policy with state laws and integrate medical cannabis into mainstream healthcare,” and urged the maintenance of the “Medical Cannabis Amendment to the Commerce, Justice, Science, and Related Agencies Appropriations Bill.”  

If the Drug Enforcement Agency follows the Department of Health and Human Services’ recommendation to move cannabis to Schedule III, it will become easier and less costly for researchers to study medical applications.

The Association of American Medical Colleges and Council on Governmental Relations said that rescheduling will “facilitate researchers’ ability to conduct research using marijuana, as compliance with Schedule III security requirements is less burdensome than those associated with Schedule I substances, while still requiring responsible storage and security protocols.” 

It could also reduce stigma and foster greater acceptance among clinicians, employers and policymakers.

But rescheduling alone will not fix the systemic challenges facing patients or businesses. Schedule III will not, by itself, make state-licensed cannabis businesses “legal” under federal law, upgrade state program design, or restore federal rights for patients. 

State medical cannabis programs, currently protected from federal interference by the Commerce, Justice and Science Appropriations Amendment, will continue to rely on Congress renewing those protections each year. 

Unlike the anti-marijuana and publicly traded cannabis companies have alluded to, IRS rules would still likely prohibit cannabis companies from deducting ordinary business expenses without a change in federal statute, despite Schedule III eliminating the application of certain tax codes. 

These rules remain in place even though the government’s own research shows medical marijuana is safe and effective. The Food and Drug Administration’s Center for Drug Evaluation and Research has found no “substantial safety concerns that would argue against the use of marijuana in any of the indications where there exists some support for its benefit.” 

Those benefits are not hypothetical — they are already transforming lives. 

Who are those patients? Older adults are one of the fastest-growing groups — one in 5 Americans ages 50–80 used cannabis in the past year, often for pain or sleep. The American Legion’s national survey found that 22 percent of veterans report using cannabis for conditions such as chronic pain, post-traumatic stress disorder and sleep problems. 

Studies show that three out of 10 patients with chronic pain use cannabis to manage pain and improve daily function, often reducing or replacing opioid treatments. The Centers for Disease Control and Prevention estimates that in 2021, 51.6 million U.S. adults lived with chronic pain. 

Meanwhile, chronic disease drives 90 percent of the nation’s $4.9 trillion in annual health care spending. Many of these conditions are poorly served by existing drugs. Cannabis-based therapies offer multi-target, multi-symptom relief, often with fewer risks than other medications, yet federal policy continues to treat cannabis as contraband. 

Finally, more than 40 percent of patients diagnosed with cancer use cannabis for sleep, mood, stress, anxiety, depression and pain. These aren’t fringe populations.  

Trump made tackling the opioid epidemic a signature priority in his first term. Research shows that access to cannabis can be part of the solution. A recent Washington Post op-ed summarized new data: Counties with cannabis dispensaries see opioid death rates drop by about 30 percent within 10 years of opening their first dispensary. 

That’s a public health outcome no policymaker should ignore. 

Also, without federal reform, the U.S. risks losing its place in the global medical cannabis market. Nearly 60 countries already have national programs, offering standardized, pharmaceutical-grade cannabis products to patients. 

U.S. companies, stuck in a patchwork of state laws and blocked from interstate commerce, can’t compete globally. That contradicts this administration’s “Made in the USA” commitment to domestic manufacturing and innovation. 

Although the president cannot simply legalize or reschedule cannabis by executive order, here’s what he can do:

• Finish rescheduling. He can direct DEA Administrator Terrance Cole to conclude the rulemaking by adopting HHS’s Schedule III recommendation through a final rule or promptly resolve the pending administrative law judge issues and move to a determination.
• Prevent congressional kneecapping. He can urge appropriators to remove Section 607 of the Commerce, Justice and Science appropriations bill, which prohibits using appropriations funds for marijuana rescheduling and endangers state medical-program protections.
• Pull out the Sharpie:  He can create an Office of Medical Cannabis and Cannabinoid Control at HHS, as outlined in model legislation created by my organization, Americans for Safe Access. He can also help to end evictions of medical cannabis patients in federal housing, allow VA doctors to recommend cannabis and end cannabis drug testing for federal employees.
• Create a real medical pathway. He can ask Congress to pass bipartisan medical cannabis legislation that moves oversight to the Office of Medical Cannabis and creates a dedicated cannabis schedule (call it Schedule VI) aligned with treaty obligations. That’s how we support patients, science and U.S. manufacturers at once.

Medical cannabis policy is, indeed, very complicated. But it’s also ripe for a bold, disruptive breakthrough, precisely the kind of challenge President Trump has built his brand on tackling. Millions of patients, hundreds of thousands of jobs, and America’s position in a global growth industry hang in the balance. 

Recognize the current accepted medical use of cannabis, protect patients and build a serious federal framework that lets American companies innovate and medical professionals practice medicine. That is disruption with a purpose.

Steph Sherer is founder and president of Americans for Safe Access.